Some Readers Comment on the Benefits of Learning About Pain

Recently I have received some great comments from readers which illustrate a very important point: pain education can help reduce threat, pain and disability. This is particularly true when it serves to alleviate threats created by well meaning health care providers who ascribe too much importance to some alleged structural pathology as the cause of the pain. I wrote about this a little in my recent post on muscle knots, and received this amazing comment from a reader relating her own experience:

Just a few thoughts on muscle “knots” and the effects of language. I’ve had leg and back pain for years now, the original trigger being a knee injury. One of the worst symptoms was severe soreness/tenderness in the IT band area of both thighs. If I poked this area with a finger, the sensation was so horrible I would feel nauseous.

A massage therapist told me that I had extensive muscle knots and scar tissue in my IT bands, and this idea was really persistent, and negative for me – I thought I had caused some major structural damage to my legs. It really made me lose confidence in my body, and my body’s ability to heal.

A few months ago, after reading some material on your website, I decided to completely stop doing stretching exercises, as an experiment. Within a few weeks, the pain and tenderness had gone, which I found quite amazing.

I think these things that some therapists may say, quite flippantly, can become obsessional for the client, and these obsessions and anxieties then stand in the way of awareness and healing.

Wow! This reader is absolutely right that well meaning therapists can cause clients a lot of anxiety by telling them about alleged defects in their body. Many of my clients have been told that their back is “out”, that they have the “neck of a seventy year old”, or that their knee is “bone on bone.” These statements can increase threat, cause disability and pain, and lead to treatments that are unnecessary or even harmful.

On that note, here’s a video that has been circulating recently showing physical therapist Peter O’Sullivan (who is of course Australian), talking with a former client, Jack, about his dramatic recovery from debilitating back pain. The successful therapy involved dealing with Jack’s fears that forward bending was unsafe, which stemmed in part from hearing previous therapists tell him that he had the “back of a seventy year old”, that his back was “in pieces” and that “he couldn’t do nothing.” But O’Sullivan showed him otherwise, and the results were amazing to say the least. This guy went from not being able to ride in a car to digging ditches pain free in short order:

Of course pain education will only rarely lead to such dramatic results, but this is an inspiring example of what is possible.

Here’s another comment from a reader I received just few days ago in response to my post on the comfort hypothesis. She mentions that after doing some reading on this site and Paul Ingraham’s site, her pain improved, partly from just learning that pain does not imply damage.

Thanks for everything you do here, between you and Paul Ingraham my low back pain is about 5% of what it was a week ago. With regards to the comfort issue, I work as an offshore fisherman, and for the last ten years or so I’ve been aboard an old beast of a scow, built in the 60′s when the design was all function and little regard for comfort. … I experienced the usual pains of hard work – you don’t throw around 80,000lbs. of shrimp in 3 days without muscle fatigue – but never once did I experience the kind of back pain I’ve been dealing with since I spent six weeks aboard a newly remodeled, supposedly ‘comfortable’ boat this fall. … I’ll take the hard life over the soft life any day!

I asked Carolyn whether her results were the result of education or some specific interventions and she responded:

The most powerful impact came simply from education. This was my first time dealing with this kind of pain and I had all the usual fears (‘will I ever be able to fish again?’ being a major one), and my pain was reduced before I tried a single practical suggestion, just by reading around a bit.

…

I’ve been playing around with a bunch of different strategies – Paul’s sweet spots were a big one to get the pain back down to the minor twitch it was before I foolishly decided to try and exercise it out – and with the pain under control I’ve been focussing more on your side of things: exploring movement options, paying attention to what I’m up to, and just slowing down in general. The hardest thing to wrap my head around was the ‘pain breeds pain’ thing; once I realized what I was doing to myself with all the poking and prodding and twisting and stretching, I went out and bought a back brace as a kind of placebo… I didn’t expect any miracles of pain relief just from the brace itself, but I used it as a way to remind me how to move (and how not to) for a few days, and to bring a sense of stillness and protection to the suffering area. After wearing it for less than 24 hours, I thoughtlessly leapt up off the couch in my old way without an ounce of pain – a movement I haven’t been able to make smoothly and unthinkingly for weeks! I’m not cured by any stretch, being out and about in the cold is still a bit of an ordeal, but that moment was the turning point, when my brain finally started to believe that maybe there wasn’t so much wrong with me after all. Thanks again and Merry Christmas!

Thanks for sharing Carolyn I really appreciate it. It’s very rewarding to hear that this blog has helped someone. I used to have chronic pain myself, and getting over it was what started me on my whole journey of learning how to move better and feel better. I have a lot of empathy and respect for others who are working through pain issues. It takes bravery, perseverance and creativity. I am very pleased whenever I can help!

12 Responses to Some Readers Comment on the Benefits of Learning About Pain

Great post! I seem to remember that the book, Painful Yarns, a metaphorical book that educates about pain was studied to find out that through better knowledge about pain, people would respond with significant pain reduction……Thank you as always for your great posts!

Excellent post and very important message about influencing patient beliefs through education and the use of metaphors. This study just out in clin journ of pain confirming the effects of metaphors on pain catastrophising but not on pain and disability:

A Randomized-controlled Trial of Using a Book of Metaphors to Reconceptualize Pain and Decrease Catastrophizing in People With Chronic Pain
Laura Gallagher, BSc (OT),* James McAuley, PhD,w and G. Lorimer Moseley, PhD*

This is a great topic! As the client’s trusted expert, what we say has incredible power to influence our client’s perceptions of themselves, their conditions, and the potential for progress or recovery. This is a great reminder to be even more mindful of what I say to my clients in regards to cause and effect. The comments you provide show us empirically that education is helpful for many, but is there any research about pain education improving people’s pain symptoms? On the ethical side and from a professional standpoint, when is it appropriate to tell that client that they may be feeding off of a fixed false belief about their pain, especially when that client’s false belief was feed to them by another professional?

I has a similar experience with a client with a stable spondylolisthesis who was in absolute agony for several years. He came to me out of desperation, not thinking I could really help him. It began as an annoying ache with occasional stabbing pain. A surgeon told him that the spondylolisthesis was the cause of his pain. He was told it was stable and he probably had it since he was a teenager. Because it was stable there was no need for surgery. He was given stabilisation exercises and his condition got worse over the years.

I pointed out that, according to the surgeon, he had the spondylolisthesis for decades and it had not changed in that time, but the pain only began several years ago. It was not logical to blame his pain on the structural problem. I detailed how pain was a protection mechanism and often tried to protect us when we did not need it.

Well, the guy who stood up to get on the treatment table was a totally different person than the guy who walked in to see me. His colour was better, he had relaxed into his body instead of maintaining exaggerated military posture and his movements were much more fluid. He actually wriggled his hips a bit, looked at me and said “How did you do that. You didn’t touch me and the pain is almost gone.”

I explained that I did nothing. Any improvements he felt were because he no longer say his spondylolisthesis as a life sentence of pain.

Oh I see. Yeah O’Sullivan’s intervention clearly involved more than just pain education, but the point of that sentence was directed more towards saying that his result was kind of an outlier rather than to precisely describe what he did.

The key thing is that what we might say, in an off-hand manner, grips on to our clients with ferocity. And we don’t know what might ‘stick’. It’s a challenge to express appropriate concern, where it might be needed, yet not condemning one to immobility & a sense of fragility that may not be accurate or needed ……

I agree it’s not simple at all, and I don’t think we could/should expect physical therapists to be psychotherapists too!
I was thinking whether I could better articulate the type of info from physios that did and didn’t help me… I think the main unhelpful things were to do with being given partial information, especially when this was coupled to the therapist seeming very certain about what they were saying. An example – one lady told me “I don’t like that facet joint” as she was massaging my back… of course I said “what does that mean!”, but all I got was a kind of vague reassurance. It would have been better to either say nothing, or, if there was a big concern, tell me to go to a doctor. As it was, I left the clinic thinking “NOW what?!” It was like that “information” just left me stranded, not knowing what to do for the best.
Other really unhelpful things were all the general comments on my anatomy (“small kneecaps”, one leg looking “worse” than the other in terms of alignment, etc etc) which just left me feeling like a collection of malfunctioning parts, each requiring a separate set of corrective exercises. And feeling like I needed a PhD in anatomy before I could get anywhere! No-one ever mentioned that none of these features were necessarily anything to do with pain.
Even as I’m writing this, I can see how these comments helped to create the perfect conditions for health anxiety to develop, which over the years has probably caused me more grief than the original physical symptoms.
Feldenkrais is kind of the opposite of all this, which is why I’ve found it so brilliantly helpful!
Hope that’s useful….